Stephen C. Joseph, MD, former assistant secretary of defense for health affairs, traveled to Haiti in February 2010 to help care for a population devastated by the magnitude 7.0 earthquake that struck in January. Following is his account of his time there.

Deciding I wanted to go down to Haiti and help out as a pediatrician in the aftermath of the earthquake, it took me only about 12 hours to hook up with a small NGO. A week or so later, I flew from Albuquerque to Miami en route to Santa Domingo and then had a 10-hour road trip to Port au Prince.

In the Miami Airport I learned that the med/surg team I was to join was stuck in the Capitol Area blizzard, and would probably be at least three days behind me. I spotted a group whose packs and small tents clearly identified them as headed for Haiti, asked them where they were going in Haiti, and if they could take along a hitch-hiker. With some travails and good luck along the way, this group of international Buddhist volunteers landed me at the Adventist Hospital in Port au Prince, where, another pediatrician was very welcome. For their part, the Buddhist Vegan group produced the miraculous feat of creating and carrying and serving 2,000 hot meals a day to hospital staff, inpatients, and discharged patients living in tents on the hospital grounds.

The media’s videos and pictures from Haiti cannot do justice to the destruction and desolation here. When the end of the world approaches, it will probably look and feel something like Port au Prince.

I arrived in Week Three, and by then most all of the emergency surgery and amputations were done. What was providing the patient load was follow-up and revision and skin-graft care of the previous surgeries, and a rising tide of medical and pediatric illness, related both to unmet burden of disease and the abysmal living conditions of tens of thousands of individuals living crowded under plastic or on the street, without rudimentary clean water, sanitation, adequate food intake, or work and income.

On the pediatric side, we ranged from 2 to 6 (volunteers coming and going at 5-10 day intervals, with controlled chaos rather than scheduling). We had a couple of pediatricians, a pediatric nurse, and an extraordinary pediatric nurse practitioner (who happened to be  accompanied by her husband, believe it or not a board-certified pediatric surgeon and former Navy captain, which put us in a wonderful situation). From day to day we weren’t sure what our staffing was, and , like most of the specialties at the hospital, we all worked at least two shifts, and most of the time something nearer 18-20 hours a day. Except for those who had small personal tents to stretch on the hospital flat roof or open corridors, most of the doctors and nurses slept on the floor in one large room on pads or air mattresses, stretched out with 35 or so of your closest friends. The spirit of sharing, commitment, and drive was probably the best I have ever experienced;  stress (mostly) was quenched by adrenalin and caring. Burn-out time seemed to be about a week.

So what did we see in pediatrics? An outpatient clinic of from 200-300 a day, ranging from the trivial to the truly frightening. We put together a reasonable facsimile of a peds ward with jerry-rigged charts and orders, holding about 15 patients. We saw mostly what you would expect in this setting: severe pneumonias, diarrhea and dehydration, sepsis and meningitis, a few severe malarias as the rains started, one true kwashiorkor and one far-advanced marasmus. Anything less sick didn’t get in.  We attended all the deliveries, 6-7 per ‘day’, and though our neonatal resuscitation equipment amounted to bulb syringe, open-tube oxygen flow from a tank, and a big floor lamp placed over the baby for warmth, we did pretty well in that department. I actually had a set of twins (whom nobody, including the mother, knew were two until the second one started coming) and a 34-week premie of a woman having an emergency C-section for eclampsia. They all survived.

A mountain of drugs and supplies had been dumped at the hospital. You had to hunt around, but could usually find what you needed, or some reasonable facsimile thereof. My years in the Third World, learning to do what you could with what you had, stood me in good stead, for example crushing adult chloroquine or Dilantin tabs and suspending them in water to make a dilution suitable for small kids—crude but  effective. The biggest lack I felt was not being able to find or liberate from somewhere else tuberculosis triple therapy for the two cases of Potts disease that I saw. Old companions from DoD answered the email, and I think a stock of triple therapy is either now at the hospital or en route.

Security within the compound was no problem, and the Marines were close by. They also would always, and I mean always, find for us what extras we needed in hospital supplies or drugs. I am not sure they were supposed to do that, but, believe me, God Bless the USMC.

Medical, nursing, and EMT volunteers from everywhere in the U.S. were in an endless supply, not always what you exactly needed when you needed it, but always enough to get the job done.

That’s the short term. The longer term is not very pleasant. When the rains start in earnest, and the tent camps become mud flats, there will be explosive infectious disease, and probably explosive social unrest. What can the future hold, in two or three months’ time, for those newborns of February? What about PT, rehab, and prostheses for the amputees? What about food, water, work, survival for hundreds of thousands? How do you rebuild the lives of those who had very little to start with, and now have almost nothing?

I would not trade the experience for anything, but I came back with a lot more questions than answers.